Provider Demographics
NPI:1740402999
Name:CHARLES H MOOREFIELD III MD PA
Entity Type:Organization
Organization Name:CHARLES H MOOREFIELD III MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOOREFIELD
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:407-843-8300
Mailing Address - Street 1:701 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4623
Mailing Address - Country:US
Mailing Address - Phone:407-843-8300
Mailing Address - Fax:407-843-6103
Practice Address - Street 1:701 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4623
Practice Address - Country:US
Practice Address - Phone:407-843-8300
Practice Address - Fax:407-843-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0040364208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF2586 RAILROADMedicare PIN
FLK2981Medicare PIN